Mechanical Circulatory Support in Patients With COVID-19 Presenting With Myocardial Infarction
2022; Elsevier BV; Volume: 187; Linguagem: Inglês
10.1016/j.amjcard.2022.09.030
ISSN1879-1913
AutoresRaviteja Guddeti, Cristina Sanina, Rajiv Jauhar, Timothy D. Henry, Payam Dehghani, Ross Garberich, Christian Schmidt, Keshav R. Nayak, Jay Shavadia, Akshay Bagai, M. Chadi Alraies, Aditya Mehra, Rodrigo Bagur, Cindy L. Grines, Avneet Singh, Rajan A.G. Patel, Wah Wah Htun, Nima Ghasemzadeh, Laura Davidson, Deepak Acharya, Ameer Kabour, Abdul Moiz Hafiz, Shy Amlani, Hal S. Wasserman, Timothy D. Smith, Navin K. Kapur, Santiago García,
Tópico(s)COVID-19 and healthcare impacts
ResumoST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19−). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19− according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19−) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis; overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19−/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%; p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19−/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%; p = 0.001) because of very high in-hospital mortality (59% vs 28%; p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19− with STEMI requiring MCS. ST-segment elevation myocardial infarction (STEMI) complicating COVID-19 is associated with an increased risk of cardiogenic shock and mortality. However, little is known about the frequency of use and clinical impact of mechanical circulatory support (MCS) in these patients. We sought to define patterns of MCS utilization, patient characteristics, and outcomes in patients with COVID-19 with STEMI. The NACMI (North American COVID-19 Myocardial Infarction) is an ongoing prospective, observational registry of patients with COVID-19 positive (COVID-19+) with STEMI with a contemporary control group of persons under investigation who subsequently tested negative for COVID-19 (COVID-19−). We compared the baseline characteristics and in-hospital outcomes of COVID-19+ and patients with COVID-19− according to the use of MCS. The primary outcome was a composite of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization. A total of 1,379 patients (586 COVID-19+ and 793 COVID-19−) enrolled in the NACMI registry between January 2020 and November 2021 were included in this analysis; overall, MCS use was 12.3% (12.1% [n = 71] COVID-19+/MCS positive [MCS+] vs 12.4% [n = 98] COVID-19−/MCS+). Baseline characteristics were similar between the 2 groups. The use of percutaneous coronary intervention was similar between the groups (84% vs 78%; p = 0.404). Intra-aortic balloon pump was the most frequently used MCS device in both groups (53% in COVID-19+/MCS+ and 75% in COVID-19−/MCS+). The primary outcome was significantly higher in COVID-19+/MCS+ patients (60% vs 30%; p = 0.001) because of very high in-hospital mortality (59% vs 28%; p = 0.001). In conclusion, patients with COVID-19+ with STEMI requiring MCS have very high in-hospital mortality, likely related to the significantly higher pulmonary involvement compared with patients with COVID-19− with STEMI requiring MCS. COVID-19 continues to have a drastic impact on all aspects of acute myocardial infarction (MI) care.1Garcia S Albaghdadi MS Meraj PM Schmidt C Garberich R Jaffer FA Dixon S Rade JJ Tannenbaum M Chambers J Huang PP Henry TD. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic.J Am Coll Cardiol. 2020; 75: 2871-2872Crossref PubMed Scopus (841) Google Scholar,2Garcia S Dehghani P Grines C Davidson L Nayak KR Saw J Waksman R Blair J Akshay B Garberich R Schmidt C Ly HQ Sharkey S Mercado N Alfonso CE Misumida N Acharya D Madan M Hafiz AM Javed N Shavadia J Stone J Alraies MC Htun W Downey W Bergmark BA Ebinger J Alyousef T Khalili H Hwang CW Purow J Llanos A McGrath B Tannenbaum M Resar J Bagur R Cox-Alomar P Stefanescu Schmidt AC Cilia LA Jaffer FA Gharacholou M Salinger M Case B Kabour A Dai X Elkhateeb O Kobayashi T Kim HH Roumia M Aguirre FV Rade J Chong AY Hall HM Amlani S Bagherli A Patel RAG Wood DA Welt FG Giri J Mahmud E Henry TD Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council. Initial findings from the North American COVID-19 Myocardial Infarction registry.J Am Coll Cardiol. 2021; 77: 1994-2003Crossref PubMed Scopus (79) Google Scholar Myocardial injury is present in 8% to 62% of patients hospitalized with COVID-19 infection and is associated with poor clinical outcomes.3Franks CE Scott MG Farnsworth CW. Elevated cardiac troponin I is associated with poor outcomes in COVID-19 patients at an Academic Medical Center in Midwestern USA.J Appl Lab Med. 2020; 5: 1137-1139Crossref PubMed Scopus (11) Google Scholar, 4Shi S Qin M Shen B Cai Y Liu T Yang F Gong W Liu X Liang J Zhao Q Huang H Yang B Huang C. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China.JAMA Cardiol. 2020; 5: 802-810Crossref PubMed Scopus (2792) Google Scholar, 5Guo T Fan Y Chen M Wu X Zhang L He T Wang H Wan J Wang X Lu Z. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19).JAMA Cardiol. 2020; 5: 811-818Crossref PubMed Scopus (2630) Google Scholar, 6Metkus TS Sokoll LJ Barth AS Czarny MJ Hays AG Lowenstein CJ Michos ED Nolley EP Post WS Resar JR Thiemann DR Trost JC Hasan RK. Myocardial injury in severe COVID-19 compared with non-COVID-19 acute respiratory distress syndrome.Circulation. 2021; 143: 553-565Crossref PubMed Scopus (73) Google Scholar Patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 infection have unique demographic and adverse clinical characteristics, including frequent in-hospital presentation, extra-cardiac manifestations such as lung infiltrates, and cardiogenic shock.2Garcia S Dehghani P Grines C Davidson L Nayak KR Saw J Waksman R Blair J Akshay B Garberich R Schmidt C Ly HQ Sharkey S Mercado N Alfonso CE Misumida N Acharya D Madan M Hafiz AM Javed N Shavadia J Stone J Alraies MC Htun W Downey W Bergmark BA Ebinger J Alyousef T Khalili H Hwang CW Purow J Llanos A McGrath B Tannenbaum M Resar J Bagur R Cox-Alomar P Stefanescu Schmidt AC Cilia LA Jaffer FA Gharacholou M Salinger M Case B Kabour A Dai X Elkhateeb O Kobayashi T Kim HH Roumia M Aguirre FV Rade J Chong AY Hall HM Amlani S Bagherli A Patel RAG Wood DA Welt FG Giri J Mahmud E Henry TD Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council. Initial findings from the North American COVID-19 Myocardial Infarction registry.J Am Coll Cardiol. 2021; 77: 1994-2003Crossref PubMed Scopus (79) Google Scholar,7Kite TA Ludman PF Gale CP Wu J Caixeta A Mansourati J Sabate M Jimenez-Quevedo P Candilio L Sadeghipour P Iniesta AM Hoole SP Palmer N Ariza-Solé A Namitokov A Escutia-Cuevas HH Vincent F Tica O Ngunga M Meray I Morrow A Arefin MM Lindsay S Kazamel G Sharma V Saad A Sinagra G Sanchez FA Roik M Savonitto S Vavlukis M Sangaraju S Malik IS Kean S Curzen N Berry C Stone GW Gersh BJ Gershlick AH International COVID-ACS Registry Investigators. International prospective registry of acute coronary syndromes in patients with COVID-19.J Am Coll Cardiol. 2021; 77: 2466-2476Crossref PubMed Scopus (52) Google Scholar STEMI patients with COVID-19 represent a high-risk group with greater odds of in-hospital mortality, stroke, recurrent MI, and repeat unplanned revascularization than those without COVID-19.2Garcia S Dehghani P Grines C Davidson L Nayak KR Saw J Waksman R Blair J Akshay B Garberich R Schmidt C Ly HQ Sharkey S Mercado N Alfonso CE Misumida N Acharya D Madan M Hafiz AM Javed N Shavadia J Stone J Alraies MC Htun W Downey W Bergmark BA Ebinger J Alyousef T Khalili H Hwang CW Purow J Llanos A McGrath B Tannenbaum M Resar J Bagur R Cox-Alomar P Stefanescu Schmidt AC Cilia LA Jaffer FA Gharacholou M Salinger M Case B Kabour A Dai X Elkhateeb O Kobayashi T Kim HH Roumia M Aguirre FV Rade J Chong AY Hall HM Amlani S Bagherli A Patel RAG Wood DA Welt FG Giri J Mahmud E Henry TD Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council. Initial findings from the North American COVID-19 Myocardial Infarction registry.J Am Coll Cardiol. 2021; 77: 1994-2003Crossref PubMed Scopus (79) Google Scholar,7Kite TA Ludman PF Gale CP Wu J Caixeta A Mansourati J Sabate M Jimenez-Quevedo P Candilio L Sadeghipour P Iniesta AM Hoole SP Palmer N Ariza-Solé A Namitokov A Escutia-Cuevas HH Vincent F Tica O Ngunga M Meray I Morrow A Arefin MM Lindsay S Kazamel G Sharma V Saad A Sinagra G Sanchez FA Roik M Savonitto S Vavlukis M Sangaraju S Malik IS Kean S Curzen N Berry C Stone GW Gersh BJ Gershlick AH International COVID-ACS Registry Investigators. International prospective registry of acute coronary syndromes in patients with COVID-19.J Am Coll Cardiol. 2021; 77: 2466-2476Crossref PubMed Scopus (52) Google Scholar In addition, patients with COVID-19 and STEMI are less likely to receive invasive angiography and reperfusion therapy, all of which may contribute to increased adverse outcomes.2Garcia S Dehghani P Grines C Davidson L Nayak KR Saw J Waksman R Blair J Akshay B Garberich R Schmidt C Ly HQ Sharkey S Mercado N Alfonso CE Misumida N Acharya D Madan M Hafiz AM Javed N Shavadia J Stone J Alraies MC Htun W Downey W Bergmark BA Ebinger J Alyousef T Khalili H Hwang CW Purow J Llanos A McGrath B Tannenbaum M Resar J Bagur R Cox-Alomar P Stefanescu Schmidt AC Cilia LA Jaffer FA Gharacholou M Salinger M Case B Kabour A Dai X Elkhateeb O Kobayashi T Kim HH Roumia M Aguirre FV Rade J Chong AY Hall HM Amlani S Bagherli A Patel RAG Wood DA Welt FG Giri J Mahmud E Henry TD Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council. Initial findings from the North American COVID-19 Myocardial Infarction registry.J Am Coll Cardiol. 2021; 77: 1994-2003Crossref PubMed Scopus (79) Google Scholar Mechanical circulatory support (MCS) is being used with increasing frequency for the management of patients with acute MI and cardiogenic shock, and clinical outcomes of MCS use have been previously reported.8Shah M Patnaik S Patel B Ram P Garg L Agarwal M Agrawal S Arora S Patel N Wald J Jorde UP. Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States.Clin Res Cardiol. 2018; 107: 287-303Crossref PubMed Scopus (169) Google Scholar, 9Basir MB Kapur NK Patel K Salam MA Schreiber T Kaki A Hanson I Almany S Timmis S Dixon S Kolski B Todd J Senter S Marso S Lasorda D Wilkins C Lalonde T Attallah A Larkin T Dupont A Marshall J Patel N Overly T Green M Tehrani B Truesdell AG Sharma R Akhtar Y McRae T, 3rd O'Neill B Finley J Rahman A Foster M Askari R Goldsweig A Martin S Bharadwaj A Khuddus M Caputo C Korpas D Cawich I McAllister D Blank N Alraies MC Fisher R Khandelwal A Alaswad K Lemor A Johnson T Hacala M O'Neill WW National Cardiogenic Shock Initiative Investigators. Improved outcomes associated with the use of shock protocols: updates from the National cardiogenic shock initiative.Catheter Cardiovasc Interv. 2019; 93: 1173-1183PubMed Google Scholar, 10Basir MB Schreiber T Dixon S Alaswad K Patel K Almany S Khandelwal A Hanson I George A Ashbrook M Blank N Abdelsalam M Sareen N Timmis SBH O'Neill Md WW. Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: the Detroit cardiogenic shock initiative.Catheter Cardiovasc Interv. 2018; 91: 454-461Crossref PubMed Scopus (175) Google Scholar However, little is known about the use of MCS in patients with COVID-19 presenting with STEMI. Although data on the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in patients with COVID-19 with severe acute respiratory failure has been reported previously, no study to date has reported on the use of MCS for cardiogenic shock in these patients. In this study, we assessed patterns of MCS utilization in patients with COVID-19 presenting with STEMI and its association with in-hospital outcomes compared with patients who are COVID-19 negative (COVID-19−). The NACMI (North American COVID-19 Myocardial Infarction) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized patients with STEMI with COVID-19 infection (confirmed or suspected) created in collaboration with the Society for Cardiovascular Angiography and Interventions (SCAI) and the Canadian Association of Interventional Cardiology in conjunction with the American College of Cardiology Interventional Council.11Dehghani P Davidson LJ Grines CL Nayak K Saw J Kaul P Bagai A Garberich R Schmidt C Ly HQ Giri J Meraj P Shah B Garcia S Sharkey S Wood DA Welt FG Mahmud E Henry TD North American COVID-19 ST-segment-elevation myocardial infarction (NACMI) registry: rationale, design, and implications.Am Heart J. 2020; 227: 11-18Crossref PubMed Scopus (24) Google Scholar A detailed description of the study rationale and design has previously been published.11Dehghani P Davidson LJ Grines CL Nayak K Saw J Kaul P Bagai A Garberich R Schmidt C Ly HQ Giri J Meraj P Shah B Garcia S Sharkey S Wood DA Welt FG Mahmud E Henry TD North American COVID-19 ST-segment-elevation myocardial infarction (NACMI) registry: rationale, design, and implications.Am Heart J. 2020; 227: 11-18Crossref PubMed Scopus (24) Google Scholar Standardized data collection forms modeled after the American College of Cardiology National Cardiovascular Data Registry definitions were used with a secure web-based application (REDCap [Research Electronic Data Capture]) to manage the dataset. In this sub-study, all patients with COVID-19+ enrolled in the NACMI registry between January 1, 2020, and November 22, 2021, were included and compared with persons under investigation for COVID-19 subsequently confirmed to be negative. Cardiogenic shock was defined as systolic blood pressure ≤90 mm Hg and cardiac index 8522 (31%)28 (39%)14 (20%)6 (8.5%)1 (1.4%)23 (23%)35 (36%)25 (26%)14 (14%)1 (1.0%)0.6127 (25%)150 (29%)127 (25%)86 (17%)24 (4.7%)200 (29%)198 (28%)162 (23%)93 (13%)42 (6.0%)0.3Race, n (%)CaucasianAfrican-AmericanAsianHispanicIndigenousOther39 (58%)7 (10%)4 (6.0%)14 (21%)1 (1.5%)2 (3.0%)63 (67%)11 (12%)6 (6.4%)8 (8.5%)1 (1.1%)5 (5.3%)0.3247 (50%)76 (15%)36 (7.2%)88 (18%)9 (1.8%)42 (8.4%)496 (75%)60 (9.1%)28 (4.2%)46 (7.0%)7 (1.1%)23 (3.5%)<0.001Non-Caucasian, n (%)28 (42%)31 (33%)0.3251 (50%)164 (25%)<0.001Weight, kg, mean±SD89±2585±230.687±2487±230.6BMI, mean±SD28±1027±120.828±1026±110.11CAD, n (%)19 (29%)34 (37%)0.3120 (26%)173 (26%)0.8Prior PCI, n (%)10 (16%)28 (30%)0.04173 (16%)113 (17%)0.7Prior MI, n (%)10 (15%)23 (25%)0.1564 (15%)104 (16%)0.5Prior CABG, n (%)2 (3.2%)5 (5.4%)0.727 (6.0%)25 (3.8%)0.093Hypertension, n (%)43 (62%)74 (78%)0.029345 (70%)481 (72%)0.4Dyslipidemia, n (%)31 (47%)55 (59%)0.13212 (45%)382 (59%)<0.001DM, n (%)28 (43%)39 (41%)0.8209 (44%)206 (31%) 0.9Smoking history, n (%)CurrentFormerNever39 (66%)11 (19%)9 (15%)46 (48%)30 (32%)19 (20%)0.091252 (53%)87 (18%)135 (28%)255 (39%)246 (38%)152 (23%)<0.001History of heart failure, n (%)14 (22%)14 (16%)0.370 (15%)65 (10%)0.011Family history of CAD, n (%)10 (25%)22 (35%)0.385 (26%)133 (29%)0.5Aspirin on admission, n (%)21 (30%)38 (39%)0.2194 (38%)193 (28%)<0.001Statin on admission, n (%)18 (25%)40 (41%)0.037193 (37%)225 (32%)0.065CABG = coronary artery bypass grafting; CAD = coronary artery disease; CHF = congestive heart failure; COVID = coronavirus disease; DM = diabetes mellitus; MCS = mechanical circulatory support; MI = myocardial infarction; PCI = percutaneous coronary intervention; SD = standard deviation; TIA = transient ischemic attack. Open table in a new tab CABG = coronary artery bypass grafting; CAD = coronary artery disease; CHF = congestive heart failure; COVID = coronavirus disease; DM = diabetes mellitus; MCS = mechanical circulatory support; MI = myocardial infarction; PCI = percutaneous coronary intervention; SD = standard deviation; TIA = transient ischemic attack. A summary of clinical and angiographic characteristics is listed in Table 2. Patients with COVID-19+ more frequently presented with dyspnea and infiltrates on chest x-ray. Cardiogenic shock pre-percutaneous coronary intervention (pre-PCI) was present in 42.6% of patients requiring MCS compared with 7.7% in those not needing MCS (p <0.001). Similarly, 27.8% of patients in the MCS group had cardiac arrest pre-PCI compared with 8.4% in the non-MCS group (p <0.001). Although all patients in the COVID-19−/MCS+ group underwent coronary angiography, 3% of patients with COVID-19+/MCS+ with STEMI did not undergo angiography. In patients who underwent coronary angiography and PCI, median door-to-balloon times were similar between patients with COVID-19+/MCS+ and COVID-19−/MCS+, and overall PCI rates (primary and rescue) were not different between the 2 groups (77% vs 76.5%, p = 0.1). Coronary artery bypass grafting was performed more frequently in patients with COVID-19−/MCS+ than patients with COVID-19+/MCS+ (13% vs 3%, p = 0.031). The distribution of the culprit vessel was similar between patients with COVID-19+/MCS+ and COVID-19−/MCS+.Table 2Clinical presentation and angiographic findingsCOVID+/MCS+ (n = 71)COVID-/MCS+ (n = 98)p ValueCOVID+/MCS- (n = 515)COVID-/MCS- (n = 695)p ValueDyspnea37 (52%)32 (33%)0.011241 (47%)223 (32%)<0.001Chest pain36 (51%)72 (73%)0.002291 (57%)566 (81%)<0.001Syncope7 (9.9%)4 (4.1%)0.215 (2.9%)34 (4.9%)0.084Infiltrates31 (44%)22 (22%)0.003195 (38%)84 (12%) 0.942 (8.2%)41 (5.9%)0.12Cardiomegaly6 (8.5%)4 (4.1%)0.345 (8.7%)42 (6.0%)0.073Arrest pre-PCI13 (21%)34 (35%)0.05634 (7.6%)68 (10%)0.13Shock pre-PCI33 (52%)39 (41%)0.242 (9.7%)51 (7.8%)0.3In-house presentation6 (8.6%)1 (1.0%)0.02133 (6.5%)10 (1.5%)<0.001Ejection fraction30+/−1332+/−140.446+/−1345+/−120.3D2B, median (IQR)82 (56, 122)77 (48, 137)0.873 (50, 109)73 (51, 102)0.9D2B (primary PCI only)94 (59, 124)78 (52, 120)0.571 (48, 106)73 (52, 100)0.6D2B <9017 (49%)33 (61%)0.2120 (64%)317 (68%)0.3No angiography2 (2.9%)0 (0%)0.268 (14%)25 (3.7%)<0.001Reperfusion strategyThrombolyticsPrimary PCIFacilitated/rescue PCIMedical therapyCABG0 (0%)53 (79%)2 (3.0%)10 (15%)2 (3.0%)0 (0%)72 (76%)3 (3.2%)8 (8.4%)12 (13%)0.1016 (3.8%)278 (67%)16 (3.8%)102 (24%)6 (1.4%)5 (0.8%)526 (80%)18 (2.7%)93 (14%)15 (2.3%)<0.001Any PCI55 (82%)75 (79%)0.6294 (70%)544 (83%)<0.001Normal coronaries (no culprit)7 (10%)4 (4.2%)0.299 (24%)74 (11%)<0.001Culprit artery*In patients who underwent coronary angiography.LMCALAD/diagonalLCx/OM/PDARCA/PDAGraftRamusMultipleNo culprit0 (0%)29 (44%)5 (7.6%)10 (15%)0 (0%)0 (0%)15 (23%)7 (11%)2 (2.1%)33 (35%)4 (4.3%)15 (16%)0 (0%)1 (1.1%)35 (37%)4 (4.3%)0.22 (0.5%)107 (26%)23 (5.6%)113 (28%)0 (0%)1 (0.2%)65 (16%)99 (24%)3 (0.5%)217 (33%)54 (8.2%)211 (32%)5 (0.8%)3 (0.5%)89 (14%)74 (11%)<0.001CABG = coronary artery bypass grafting; COVID = coronavirus disease; D2B = door-to-balloon; IQR = interquartile range; LAD = left anterior descending artery; LCx = left circumflex artery; LMCA = left main coronary artery; MCS = mechanical circulatory support; PCI = percutaneous coronary intervention; PDA = posterior descending artery; RCA = right coronary artery; SD = standard deviation. In patients who underwent coronary angiography. Open table in a new tab CABG = coronary artery bypass grafting; COVID = coronavirus disease; D2B = door-to-balloon; IQR = interquartile range; LAD = left anterior descending artery; LCx = left circumflex artery; LMCA = left main coronary artery; MCS = mechanical circulatory support; PCI = percutaneous coronary intervention; PDA = posterior descending artery; RCA = right coronary artery; SD = standard deviation. Right-sided cardiac catheterization was performed in about 39% of patients with COVID-19+/MCS+ compared with 0.928 (21, 35)30 (28, 45)0.12Wedge (mean) mm Hg22 (17, 34)19 (16, 28)0.515 (9, 24)23 (17, 29)0.051Cardiac output, L/min3.15 (2.35, 3.94)3.90 (3.14, 6.16)0.0684.20 (3.49, 5.44)4.09 (3.40, 5.79)0.7Cardiac index, L/min/m21.94 (1.59, 2.56)1.90 (1.30, 2.62)0.72.04 (1.75, 2.82)2.25 (1.89, 3.12)0.4Intubated, n (%)45 (74%)50 (55%)0.019102 (23%)79 (12%)<0.001SCAI cardiogenic class, n (%)*SCAI cardiogenic shock classification data were available for all patients in the COVID-19–/MCS+ group and 65 patients in the COVID-19+/MCS+ group.ABCDE0 (0%)0 (0%)0 (0%)40 (62%)25 (38%)0 (0%)0 (0%)0 (0%)50 (51%)48 (49%)COVID = coronavirus disease; IQR = interquartile range; LAD = left anterior descending artery; LVEDP = left ventricular end-diastolic pressure; MCS = mechanical circulatory support; PAP = pulmonary artery pressure; RA = right atrium; RV = right ventricle; SCAI = Society of Cardiovascular Angiography and Intervention. SCAI cardiogenic shock classification data were available for all patients in the COVID-19–/MCS+ group and 65 patients in the COVID-19+/MCS+ group. Open table in a new tab COVID = coronavirus disease; IQR = interquartile range; LAD = left anterior descending artery; LVEDP = left ventricular end-diastolic pressure; MCS = mechanical circulatory support; PAP = pulmonary artery pressure; RA = right atrium; RV = right ventricle; SCAI = Society of Cardiovascular Angiography and Intervention. Intra-aortic balloon pump (IABP) was the most common type of MCS used in both groups (74% and 62% in COVID-19−/MCS+ and COVID-19+/MCS+, respectively; Figure 2). Although Impella use was comparable between the 2 groups (21% in COVID-19−/MCS+ and 28% in COVID-19+/MCS+), the use of ECMO was numerically higher in the COVID-19+/MCS+ group (COVID-19+ 7% vs COVID-19− 3%, p = 0.11). The primary outcome occurred in 58% of patients with COVID-19+/MCS+ and 28% of patients with COVID-19−/MCS+ (p <0.001). The difference was driven by higher in-hospital mortality (55% in the COVID-19+/MCS+ group vs 27% in the COVID-19−/MCS+ group; p = 0.001) with no difference in stroke, recurrent MI, or unplanned revascularization. Length of intensive care unit and total length of hospital stay were not significantly different between COVID-19+/MCS+ and COVID-19−/MCS+ groups, although significantly longer when compared with patients with COVID-19+/MCS− and COVID-19−/MCS− (Figure 3). Left ventricular ejection fraction was significantly lower in the COVID-19+/MCS+ group compared with patients with COVID-19+/MCS− (30 ± 13% vs 46 ± 13%, p <0.001; Supplementary Tables 1 and 2). Coronary angiography was not performed in 2.9% and 14% of patients with COVID-19+/MCS+ and COVID-19+/MCS−, respectively (p = 0.009). In contrast, PCI (both primary and rescue) was performed in 82% of patients in the COVID-19+/MCS+ group compared with 70.8% in the patients with COVID-19+/MCS− (p = 0.10). Left anterior descending coronary artery was the predominant culprit vessel in patients with COVID-19+/MCS+, whereas the right coronary artery was the major culprit vessel in patients with COVID-19+/MCS−. The primary end point occurred in 25% of patients with COVID-19+/MCS− in comparison with 58% in patients with COVID-19+/MCS+ (p <0.001) (Figure 3, Supplementary Table 3). We used the NACMI registry to describe clinical and angiographic characteristics, patterns of MCS utilization, and in-hospital outcomes of patients with STEMI and concomitant COVID-19 infection. Several important findings are noted. First, MCS was used in 12.3% of patients with COVID-19+ presenting with STEMI, which is comparable with patients with STEMI without COVID-19. Second, in patients treated with MCS, ECMO use was significantly higher in patients with COVID-19+/MCS+ compared with COVID-19−/MCS+. Third, despite use of patients with MCS, COVID-19+ had significantly higher in-hospital mortality rates than patients with COVID-19−/MCS+. Fourth, when compared with a control group composed of patients with COVID-19 needing MCS devices, patients with COVID-19+ had a similar proportion of high-risk pre-PCI conditions (cardiogenic shock and cardiac arrest). Fifth, although most patients with STEMI and COVID-19+ infection in the NACMI registry were from ethnic minorities,2Garcia S Dehghani P Grines C Davidson L Nayak KR Saw J Waksman R Blair J Akshay B Garberich R Schmidt C Ly HQ Sharkey S Mercado N Alfonso CE Misumida N Acharya D Madan M Hafiz AM Javed N Shavadia J Stone J Alraies MC Htun W Downey W Bergmark BA Ebinger J Alyousef T Khalili H Hwang CW Purow J Llanos A McGrath B Tannenbaum M Resar J Bagur R Cox-Alomar P Stefanescu Schmidt AC Cilia LA Jaffer FA Gharacholou M Salinger M Case B Kabour A Dai X Elkhateeb O Kobayashi T Kim HH Roumia M Aguirre FV Rade J Chong AY Hall HM Amlani S Bagherli A Patel RAG Wood DA Welt FG Giri J Mahmud E Henry TD Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council. Initial findings from the North American COVID-19 Myocardial Infarction registry.J Am Coll Cardiol. 2021; 77: 1994-2003Crossref PubMed Scopus (79) Google Scholar those who received MCS were predominantly Caucasian. Patients with COVID-19+ had significantly higher rates of the composite primary end point driven primarily by very high rates of in-hospital mortality and abnormal lung findings (i
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